Comparison of surgical site infection in pediatric patients using NSQIP-P data during COVID-19 pandemic and non-pandemic periods.

Abstract

Introduction: Surgical site infections (SSIs) remain a significant post-operative complication, with rates varying across populations. The COVID-19 pandemic led to heightened infection control measures, which were expected to lower SSI rates. However, existing studies mainly focus on adult populations, leaving a gap in understanding the pandemic's impact on pediatric surgeries.

Methods: We used the National Surgical Quality Improvement Program in Pediatric Surgery (NSQIP-P) database to analyze SSI rates and lengths of stay (LOS) for pediatric patients from 2018 to 2021. We compared data from pre-pandemic (2018-2019) and pandemic (2020-2021) periods, adjusting for confounding variables, such as patient demographics, comorbidities, and surgical specialties.

Results: Among 472,581 cases analyzed, SSI rates increased from 2.5% pre-pandemic to 2.88% during the pandemic. While the percentage of patients with LOS exceeding 2 days slightly decreased, SSI rates for those with prolonged LOS increased, highlighting a strong association between extended hospitalization and SSI risk. Pediatric Otolaryngology had the highest adjusted odds ratio (OR) for SSI (1.393), while pediatric surgery had the lowest (1.097).

Discussion: Despite enhanced infection control protocols, SSI rates in pediatric surgeries increased during the COVID-19 pandemic. These findings emphasize that infection control measures alone may have been insufficient to mitigate SSIs in pediatric populations, even with efforts to reduce LOS. Further research is needed to explore the pandemic's broader impact on pediatric surgical outcomes and the relationship between LOS and SSIs.

Levels of evidence: Observational study, Level III.